Stereotyping in medical student decision-making: presence, origins and solutions

医学生决策中的成见：存在、起源和解决方案

• 批准号: 8149882
• 负责人: ROBERT L WILLIAMS
• 金额: $ 37.37万
• 依托单位: UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8149882
• 关键词: Address; Admission activity; African American; Area; Cardiac; Cardiac Catheterization Procedures; Caring; Case Study; Clinical; Communication; Confounding Factors (Epidemiology); Coronary Artery Bypass; Data; Data Collection; Decision Making; Development; Disease; Educational Curriculum; Environment; Faculty; Gender; Goals; Health; Health Services; Income; Insurance Coverage; Interview; Mails; Medical; Medical Students; Minority Groups; Morbidity - disease rate; Not Hispanic or Latino; Outcome; Patients; Pattern; Peer Review; Perception; Physician-Patient Relations; Physicians; Plant Roots; Play; Policy Maker; Prevalence; Preventive; Procedures; Process; Psychological reinforcement; Publications; Publishing; Race; Recommendation; Reporting; Research; Research Personnel; Role; Sampling; Schools; Services; Sex Bias; Socioeconomic Status; Solutions; Stereotyping; Students; Surveys; Therapeutic; Training; Trust; Uncertainty; base; coronary angioplasty; evidence base; evidence based guidelines; experience; health care delivery; health disparity; informant; innovation; interest; medical schools; mortality; multidisciplinary; programs; public health relevance; racial and ethnic; response; social health determinants

DESCRIPTION (provided by applicant): Many studies have shown that racial and ethnic minorities do not receive therapeutic medical procedures at the same rates as non-Hispanic whites, with the strongest evidence of these racial disparities in the utilization of invasive cardiac procedures. The causes of these racial disparities remain unclear, but geographic and financial access, underlying morbidity, insurance status, and income cannot fully explain the differences. There is suggestive evidence that a contributing factor is a difference in the rate at which physicians offer these procedures to patients based on race and/or gender, and that such biases may be present in medical students. This innovative, multidisciplinary, multimethod study will investigate the prevalence and determinants of racial and gender biases in medical decision-making under conditions of scientific uncertainty of senior medical students. It will further develop information about the dynamics by which non-clinical factors become part of student medical decision-making, and the training environment in which this takes place. In doing so, the study will provide essential guidance to medical educators and developers of cultural competency training who aim to reduce the impact of this social determinant of health and accompanying racial and gender disparities in health service delivery. A nationwide mail survey of senior allopathic medical students will first be conducted to determine the prevalence of such biases using a set of clinical vignettes in which the race and gender of the "patient" will vary among the sample. The influence of "patient" race, gender and socioeconomic status on the rates of procedural recommendation by the students will be analyzed. Ecological case studies will then be conducted at each of 14 purposively selected medical schools to explore the context and dynamics of formation of student medical decision-making. Schools for the case studies will be selected based on summaries of response patterns to the survey, with sampling of schools for study that demonstrate greater or lesser degrees of influence of race and gender on their students' responses. In-depth interviews of students, faculty and staff key informant interviews, examination of cultural competency and student curricula and of admission processes are some of the data collection processes that will be used to explore the context in which student decision-making processes are formed, reinforced, or reduced. The findings of the combined survey and case studies will be used to prepare reports for schools, policy makers, and peer-reviewed scientific presentations and publications. The specific objective of this study is to develop and disseminate evidence-based recommendations for medical educators and developers of cultural competency training interested in reducing the role that such biases play in racial and gender disparities in health services delivery. PUBLIC HEALTH RELEVANCE: This multidisciplinary study will investigate the prevalence and origins of racial- and gender- based biases in medical decision-making, and make evidence-based recommendations for eliminating these biases. Previous published evidence suggests this understudied social determinant of health is a contributor to health disparities experienced by many in the U.S.

描述（由申请人提供）：许多研究表明，种族和少数民族没有以与非西班牙裔白人相同的速度接受治疗性医疗程序，在利用侵入性心脏手术中，这些种族差异的最有力证据。这些种族差异的原因尚不清楚，但是地理和财务获取，基本的发病率，保险状况和收入无法完全解释差异。有暗示的证据表明，一个因素是医生根据种族和/或性别向患者提供这些程序的差异的差异，并且医学生可能存在这种偏见。 这项创新的，多学科的多途径研究将调查在高级医学生的科学不确定性条件下，医疗决策中种族和性别偏见的患病率和决定因素。它将进一步开发有关非临床因素成为学生医学决策的一部分以及发生这种情况的动态的信息。在此过程中，这项研究将为医学教育者和文化能力培训的开发商提供必要的指导，他们旨在减少这种社会决定因素的影响，并伴随着卫生服务提供的种族和性别差异。 首先，将对高级同种疗法医学生的全国性邮件调查，以确定此类偏见的流行，使用一组临床小插曲，在样本中，“患者”的种族和性别将有所不同。将分析“患者”种族，性别和社会经济地位对学生程序推荐率的影响。 然后，将在有意选择的医学院中的每所医学院中的每所研究中进行生态案例研究，以探讨学生医疗决策的形成的背景和动态。案例研究的学校将根据对调查的响应模式的摘要进行选择，并通过对研究进行抽样，以表明种族和性别对学生的反应的影响或多或少。对学生，教职员工主要线人的访谈，文化能力和学生课程的审查以及入学过程的深入访谈是一些数据收集过程，这些过程将用于探索在形成，加强或减少学生决策过程的环境中。合并调查和案例研究的结果将用于为学校，政策制定者以及经过同行评审的科学演示和出版物准备报告。 这项研究的具体目标是为医学教育者和文化能力培训的开发商开发和传播基于证据的建议，对减少这种偏见在卫生服务提供中的种族和性别差异中所起的作用感兴趣。 公共卫生相关性：这项多学科研究将调查基于种族和性别的医疗决策偏见的普遍性和起源，并提出基于证据的建议，以消除这些偏见。以前发表的证据表明，这种研究的健康决定因素是美国许多人经历的健康差异的贡献者